Researching Clogged Arteries in Type 2
Investigating artery changes in younger people with type 2
Matthew Budoff, MD
Cardiologist, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
ADA Research Funding
Clinical Translational Research
Heart disease is something everyone should worry about, but people with type 2 diabetes have more reason to worry than most. “Diabetes is the strongest risk factor for heart disease,” says Matthew Budoff, MD, a cardiologist at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. “It’s the only thing that really matters.” Heart attacks and strokes kill 70 percent of people with type 2 diabetes, compared with about 30 percent of people without diabetes. (People with type 1, however, have a higher risk than the general population but not as high as people with type 2.)
Researchers have been working for decades to understand how diabetes and heart disease connect, and to break the deadly link. One success story has been the widespread use of drugs called statins, which reduce the risk of heart attack and reverse the buildup of artery-clogging plaque.
Statins’ impact on people with diabetes was underscored in 2003, when the results of the MRC/BHF Heart Protection Study were announced. The landmark study—which followed more than 20,000 people with heart disease, including nearly 6,000 patients with diabetes, for five years—showed that statins are a powerful tool in the fight against heart disease. For people with diabetes, the study found statins could reduce the risk of heart attack and stroke by up to a third.
The study convinced the American Diabetes Association to recommend that people with diabetes receive statins—but only if they’re over a certain age. “The ADA guidelines say over 40 because that’s where the science is,” says Budoff. “But the studies were all done with people in their 40s and above.”
But science, Budoff says, may not be keeping pace with the way type 2, once known as “adult-onset diabetes,” has developed. “The trend is [a] much higher prevalence of type 2 in the setting of younger and younger patients,” he says. According to the Centers for Disease Control and Prevention, the number of people between 18 and 45 who develop type 2 diabetes each year has nearly doubled since 1980, from 1.7 people per 1,000 to 3.3 per 1,000 in 2011.
That’s why Budoff worries research such as the Heart Protection Study, which focused on heart disease in older people, overlooks or obscures an important possibility: Cardiovascular disease may get its start much earlier in life. By the time doctors begin treating it, there may be irreversible damage. “It’s important for doctors to know if they should be looking for the signs of heart disease earlier,” he says.
With the help of a grant from the ADA, Budoff is trying to determine whether people under 40 with type 2 diabetes are also at risk for heart disease. He’s looking for one thing in particular: plaque, a buildup of fats that clings to artery walls, clogging and stiffening them. It’s a key indicator of heart disease risk, and something statins have been shown to reduce. “We wanted to see what the prevalence of plaque was like in people younger than 40,” Budoff says.
To find out, he’s studying 200 people, all between the ages of 25 and 40. Half have had type 2 diabetes for at least five years, and the other half don’t have the disease. Wherever possible, Budoff has tried to match people in the two groups for factors such as age, ethnicity, and weight so the groups are as comparable as possible.
Participants come into the lab for blood tests and close-up looks at their heart and carotid arteries, the big blood vessels in the neck. Except for the blood test, the study is noninvasive: Budoff uses an ultrasound to look for plaque in the carotid artery, for example.
When the numbers are in, Budoff expects to see a difference between the two groups, namely more plaque in the arteries of younger people with diabetes than in their peers without the disease. People ages 30 to 40, in particular, could be at risk—and might benefit from treatment.
That, in turn, could change standards of care for younger people with type 2. They might benefit from tests that are, right now, routine only for at-risk people over 40, such as carotid ultrasounds. And future research might help determine whether more aggressive treatment can help young people avoid heart disease later in life. “After we prove that there’s a population that needs to be treated, maybe we’ll do a study in 30- to 40-year-olds to see if they really benefit [from statins and other drugs],” Budoff says.
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